Health benefits of gastric bypass surgery after 6 years

Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122-1131.  

Background
Recent trials have examined the benefits of bariatric surgery with regard to remission and prevention of type 2 diabetes in obese individuals.1-3 Are these benefits durable?

Design
This prospective study by Adams and colleagues explored the weight loss and cardiometabolic benefits of Roux-en-Y gastric bypass (RYGB) among severely obese patients over 6 years of follow-up. Patients who sought and received RYGB (n=418) were compared with two nonsurgical, noninterventional control groups: control group 1 sought but did not have RYGB (n=417), and control group 2 was comprised of a random population-based sample without prior history of bariatric surgery (n=321).

The main outcome measures included weight loss, type 2 diabetes,* hypertension,† and dyslipidemia,‡ which were compared between subjects who underwent RYGB and the control groups. (Click here for slide.) 

Results at Year 6 post-surgery
Weight loss

Patients who underwent RYGB surgery had a 27.7% reduction in weight from baseline (95% confidence interval [CI], 26.6 to 28.9), with 96% maintaining >10% weight loss, and 76% maintaining >20% weight loss. Percent weight gain in control groups 1 and 2 was 0.2% (95% CI, -1.1% to 1.4%) and 0% (95% CI, -1.2% to 1.2%), respectively. (Click here for slide.) 

Diabetes remission§
The rate of diabetes remission among surgical patients was 62% (95% CI, 49%-75%). In control groups 1 and 2, the rates of remission were 8% (95% CI, 0%-16%) and 6% (95% CI, 0%-13%), respectively. Remission odds ratios (ORs) were 16.5 (95% CI, 4.7-57.6; P<0 .001) compared with control group 1 and 21.5 (95% CI, 5.4-85.6; P<0.001) compared with control group 2. (Click here for slide.) 

Diabetes incidenceDiabetes incidence was 2% in the surgery group (95% CI, 0%-4%), compared to 17% in control group 1 (95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 for surgery group compared with control group 1; P<0.001) and 15% in control group 2 (95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 for surgery group compared with control group 2; P<0.001). (Click here for slide.) 

Additional cardiometabolic outcomes
Incidence (Click here for slide) and remission§ (Click here for slide) of hypertension and dyslipidemia values showed greater improvement for surgical patients compared with either control group.

Baseline Characteristics
Participants were primarily female (82%) and non-Hispanic white (96%); body mass index [BMI] was ≥35 kg/m2 (mean BMI: 45.9 kg/m2).

*Defined as fasting blood glucose ≥126 mg/dL, A1C ≥6.5%, or use of antihyperglycemic medication
†Defined as resting blood pressure ≥140/90 mm Hg or use of antihypertensive medication
‡Considered present if fasting LDL-C ≥160 mg/dL, fasting HDL-C <40 mg/dL, fasting triglycerides ≥200 mg/dL, or use of lipid-lowering medication
§Remission defined as return to normal levels without reported medication use for the specified outcomes

1. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567-1576.
2. Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420-1428.
3. Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695-704.

 

December 2012  

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Related content: 

Clinical Insights® in Diabetes :: November 2012  

Overview and slides: Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects 

 

Last Modified: 11/15/2013